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Title: Morbidity in general practice
Author: Ireland, George W.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1970
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Abstract:
Detailed studies of health and disease have in the main been confined to urban communities. Inspired by Sir James McKenzie and supported by the Nuffield Foundation and the Secretary of State for Scotland on the advice of the Advisory Committee for medical liesearch the author has made a study of morbidity in his patients over a 7 year period up to his retirement in 1964. The study was based on a stable rural community and involved 2498 patients living in the Tillage of Pathhead, Ford, Midlothian and its immediate surroundings. The family was chosen as the basic unit in the survey and both morbidity and sociological data were kept in a Family "Folder designed and arranged for ease of recording, tabulating and coding. Although all records were kept in documents specifically designed for the survey the International Classification of "Diseases, 7th revision 1255, was used exclusively in recording illness. Criteria concerning the functional and social effectiveness of family groups were devised and on the basis of the authors experience of the families over the preceeding 30 years each was placed in one of three broad categories ranging from those showing no apparent economic, social or health defect to those displaying frank evidence of such stresses as marital disharmony, broken homes, divorce, illegitimacy, unemployment and chronic ill-health. Thereafter all morbidity recorded in the practice was related to the defined family categories. After recording total morbidity occurring within the community for three years, it became clear that the ill-defined group of Diseases was large, insofar as 2,720 out of a total of 12,231 episodes in a three-year period were in the ill-defined group. It was therefore decided to make a special study of this group while continuing the general recording of illness and social factors. Accordingly a detailed retrospective study was made and in the process of analysis it became evident that a large percentage of the symptoms and signs within this group were features of Stress disorders. To examine this aspect a definition of stress disorders was adopted and a. list of stress diseases prepared. Although a large percentage of the ill-defined conditions proved to belong to the group of Stress disorders the results left much to be desired, in particular they were obtained from a retrospective study. In an attempt to overcome this deficiency a prospective study of Stress disorders was made after designing a proforma on which 74 items of Stress disorders were listed in addition to all other morbidity. Thereafter any patient presenting with one or more of the 74 features within the arbitrarily defined stress group was studied in detail and the total morbidity within this group compared with patients presenting with diseases other than the defined stress disorders. The latter control group were obtained by selecting every fifth National Health Service Card, discarding any with known stress and selecting the next card instead. The severity of the Stress disorders was classified into three main groups (itnapffian, 1962) namely: 1. Stress symptoms or minor psychosomatic disorders. 2. Major Psychosomatic disorders. 3. Intermediate. By distinguishing between early and. more severe cases this grouping has particular relevance to a general practice survey. As a result of this prospective study it was found that 12,1/' of the total episodes per year were within the classification of Stress disorders. Group 1, or minor psychosomatic disorders proved to be the largest. However, general practice work load, measured by doctor-patient contact, was highest in group 2 and lowest in group 1» In all three groups females outnumbered males by 2 to 1. In all groups more patients considered their condition to have a physical rather than a. psychogenic cause. Of the factors of possible relevance to Stress disorders studied, the commonest in relative frequency were 1. Constitution! 2, Interpersonal} 3, Subjective? 4 Psychiatric Health of Parent a; 5 Heredity and 6. Work. In many instances several factors were relevant. Although a large number in all groups were given drug therapy to relieve somatic complaints or to act as mild sedatives, hypnotics or less often as tranquilizers, only 15/ required either psychiatric or other hospital consultative .services. Of 24 psychiatric references 18 were from group 2. Nevertheless, many patients in group 1 were slightly or moderately disturbed from the social aspect. 50% in group 1 ceased to require medical care after one year whereas 60% of sen and 95% of women in group 2 continued to need medical attention and 6% of patients were permanently unfit for work. When total morbidity was examined, there was in general a significantly higher percentage of diseases other than stress conditions in groups 1, 2 and 3 by comparison with the random sample of control patients. On the basis of this study it is concluded that Ill-defined and Stress disorders occupy a major aspect of doctor-patient contact and prescribing in general practice. It is conceeded that this study has been confined to one observers view of a stable rural community. However further studies in depth in other urban communities might reveal evidence of considerable social and medical significance in population health. In the practice and science of medicine much attention has been focused upon clearly defined diseases. Those conditions, however, which are less clearly defined should not he overlooked.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.777453  DOI: Not available
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